Regenerative Endodontic Therapy in the Management of Immature Necrotic Permanent Dentition: A Systematic Review

Abstract

Background and Objective. Management of immature permanent teeth exhibiting necrotic pulp is clinically challenging. An appropriate diagnosis, case selection, and good management ensure good outcomes. The objective of this review reviews all up-to-date data in regard to endodontic regeneration therapy in the management of immature permanent teeth with necrotic pulp and which conducts are most used and appropriate for this procedure in human and animal investigations. Materials and Methods. The electronic databases PubMed and Google Scholar were used to search the literature for relevant studies after applying specific inclusion and exclusion criteria. Studies that fulfilled both the inclusion and exclusion criteria were included in this systematic review. The search was conducted by two independent reviewers following the PRISMA guidelines. Results. Only 46 studies that fulfilled both the inclusion and exclusion criteria, which were conducted within the last 10 years, were included in this systematic review. These studies investigated different aspects of regenerative endodontic therapy including different types of scaffolds, intracanal medications, pulpal space/barriers, root maturation stage, follow-up duration, and updated studies on their use in the management of immature necrotic permanent teeth. Conclusions. This review concluded the compiled data observed that endodontic regenerative therapy was more efficient in treating immature necrotic permanent teeth and offered a greater advantage that should lead to wider acceptance among endodontists for effective results compared to different treatment options. However, more clinical trials with a standardized protocol and defined clinical, radiographic, and histopathological outcomes with longer follow-up periods are warranted.

Regenerative Endodontic Procedures: An Umbrella Review

“…Overall, twenty SRs without meta-analysis [ 4 , 5 , 6 , 7 , 8 , 9 , 12 , 13 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ] and nine SRs with meta-analysis were included [ 10 , 11 , 14 , 15 , 34 , 35 , 36 , 37 , 38 ] ( Table 1 ). Multiple sub-topics were investigated, such as REP protocols and outcomes [ 4 , 5 , 7 , 9 , 11 , 12 , 13 , 14 , 15 , 22 , 27 , 29 , 36 ], solely REP protocols [ 30 , 37 ], solely outcomes [ 6 , 8 , 10 , 23 , 28 , 38 ], and stem cells on REP [ 24 , 25 , ...…”

“…Six SRs failed to report a defined timeframe [ 6 , 9 , 14 , 26 , 28 , 31 ]. Seven SRs did not report language restrictions [ 11 , 22 , 23 , 31 , 33 , 35 , 38 ], twelve applied a language restriction as an inclusion criterion [ 8 , 10 , 12 , 13 , 14 , 15 , 24 , 26 , 28 , 29 , 32 , 36 , 37 ], and the remaining had no language restriction [ 4 , 5 , 6 , 7 , 9 , 25 , 27 , 30 , 34 ].…”

“…None of the included SRs fully satisfied the AMSTAR2 Criteria ( Table 2 ). Overall, two were rated as “high quality” [ 15 , 37 ], fourteen as “moderate quality” [ 5 , 7 , 9 , 10 , 11 , 13 , 25 , 27 , 28 , 29 , 31 , 34 , 35 , 36 ], three as “low quality” [ 6 , 8 , 12 ], and ten were assessed as “critically low quality” [ 4 , 14 , 22 , 23 , 24 , 26 , 30 , 32 , 33 , 38 ]. Major concerns regarding methodological quality were found on the: (a) lack of information regarding the type of included studies; (b) the literature search strategy; (c) the absence of a list of excluded studies with justification; and (d) declaration of funding sources.…”

“…Fifteen SRs investigated the efficacy of REP protocols [ 4 , 5 , 7 , 9 , 11 , 12 , 13 , 14 , 15 , 22 , 27 , 29 , 30 , 36 , 37 ]. Twelve SRs investigated human teeth exclusively [ 4 , 5 , 7 , 9 , 11 , 13 , 14 , 15 , 27 , 30 , 36 , 37 ] and three included studies with human and animal teeth simultaneously [ 12 , 22 , 29 ]. Overall, REP protocols reported generic removal of necrotic pulp through minimal or no mechanical instrumentation [ 5 , 7 , 15 , 22 , 27 , 28 , 29 ].…”

“…In light of these considerations, Regenerative Endodontic Procedure (REP) is described as “biologically based procedures designed to replace damaged structure” and aims to deliver a suitable environment to promote natural regeneration/repair with a functional pulp–dentin wall and apical closure [ 2 , 3 ]. Therefore, REPs have the potential to increase root length, to thicken the rootwall, and to achieve apical closure [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ].…”